ARDS is characterized clinically by dyspnea, tachypnea, tachycardia, cyanosis, and hypoxemia. PaO2/FIO2 remains low (below 2 cc) even with oxygen therapy at high oxygen concentrations. The lung compliance is decreased so that the lung is stiffer and more difficult to ventilate. Chest radiographs show signs of bilateral interstitial and alveolar edema. Cardiac filling pressures are normal, and the pulmonary capillary wedge pressure is below 18 torr.

Most authorities consider that the syndrome has three phases or stages that characterize its progression: the exudative stage, the fibroproliferative or proliferative stage, and the resolution or recovery stage. The exudative stage comes first, two to four days after onset of lung injury, and is distinguished by the accumulation of excessive fluid in the alveoli with entrance of protein and inflammatory cells from the alveolar capillaries into the air spaces. The fibroproliferative stage comes second and is characterized by an increase in connective tissue and other structural elements in the lungs in response to the initial injury. It begins between the first and third weeks after the initial injury and may last up to ten weeks. Microscopic examination reveals lung tissue that appears densely cellular. The patient is at risk for pneumonia, sepsis, and pneumothorax at this time. The third stage is the resolution or recovery stage. During this stage the lung reorganizes and recovers, although it continues to show signs of fibrosis. Lung function may continue to improve for as long as six to twelve months or even longer, depending on the precipitating condition and severity of the injury. It is important to remember that there are often different levels of pulmonary recovery in patients with ARDS.

Some authorities refer to a fourth phase or stage of ARDS, the period after the resolution or recovery stage. Some patients continue to experience health problems caused by the acute illness, such as coughing, limited exercise tolerance, and fatigue. Anxiety, depression, and flashback memories of the critical illness may also occur and be similar to posttraumatic stress disorder.

Treatment and Patient Care. Mechanical ventilation must be begun at the first signs of hyperventilation and hypoxemia, before obvious signs of respiratory distress develop. A cuffed endotracheal tube or tracheostomy tube is used to maintain an airway. The patient is ventilated at the lowest oxygen concentration that maintains the arterial oxygen saturation (SaO2) at 90 per cent. positive end-expiratory pressure (PEEP) or continuous positive airway pressure (CPAP) may be used to increase the number of alveoli that remain open at the end of exhalation and thus decrease pulmonary shunt. hemodynamic monitoring, using a swan-ganz catheter, is done to measure cardiac output, pulmonary capillary wedge pressure, and right atrial wedge pressure. An arterial line is placed to continuously monitor blood pressure and measure arterial blood gases. A diuretic such as furosemide (Lasix) may be administered to reduce fluid volume overload and pulmonary edema. If infection develops, antibiotics are administered. Hemodynamic parameters, arterial blood gas levels, intake and output, breath sounds, vital signs, inspiratory pressure, tidal volume, inspired oxygen concentration, and end-expiratory pressure are all continuously monitored.

acute stress disorder an anxiety disorder characterized by development of anxiety, dissociation, and other symptoms within one month following exposure to an extremely traumatic event, the symptoms including reexperiencing the event, avoidance of trauma-related stimuli, anxiety or increased arousal, and some or all of the following: a subjective sense of diminished emotional responsiveness, numbing, or detachment, derealization, depersonalization, and amnesia for aspects of the event. If persistent, it may become posttraumatic stress disorder.

Conclusion1 death, 1 re-infarction at a new lesion; the left ventricular ejection fraction at follow-up increased by 29%, from 45 to 74%; primary coronary UT in high clot-burden lesions induces re-perfusion and highly significant myocardial salvage.

(2) Assessment of Cardioversion Utilizing Transesophageal Echocardiography. A trial comparing the feasibility and safety of TEE-guided early cardioversion to conventional cardioversion in atrial fibrillation.

acute,

adj pertaining to a traumatic, pathologic, or physiologic phenomenon or process having a short and relatively severe course. Antonym: chronic.

acute phase reactions,

n.pl the abnormalities in the blood associated with acute and chronic inflammatory and necrotic processes and detected by a variety of tests, including erythrocyte sedimentation rate, C-reactive protein, serum hexosamine, serum mucoprotein, and serum nonglucosamine polysaccharides.

acute

1. brief.

2. common usage is 'having severe signs and a short course of 12 to 24 hours'. See also under organ (e.g. pancreatitis), system (e.g. respiratory), causative agent (e.g. arsenic) or lesion (e.g. myonecrosis).

sudden death, for no apparent reason, in 2 to 3 week old broiler chicks; clinical signs of falling, wing flapping and convulsions may occur for about a minute before death.

acute phase response

the rapid change in composition of certain plasma proteins, largely due to alteration in hepatic synthesis, in response to infection or inflammation. Although the purpose is not well understood, these changes are believed to assist in immune response. Erythrocyte sedimentation rate (ESR) is a laboratory indicator of the acute phase response. See also c-reactive protein and tumor necrosis factor.

Patient discussion about acute

Q. What is Acute Appendictis? My husband had to go to the emergency room last night because of sudden severe stomach aches. The doctors said he had acute appendictis and needed urgent operation. What is acute appendicitis?

A. The term 'Appendictis' refers to an inflammed appendix, an organ that is located in the right lower part of the abdomen, attached to the cecum, which is a part of the intestine. The appendix is often infected with intestinal bacteria, and such an infection can cause severe symptoms, that require receiving emergent medical care. If indeed acute appendicitis is diagnosed, the treatment involves immediate surgery, for the removal of the infected appendix.

Q. I had an acute neck pain and now hand pain. I had an acute neck pain which is now gone with some self medication but now i have pain in my left hand muscles. Help

A. can be caused by number of things. but you have to be more specific, what kind of pain? when is it ? mornings? evenings? does it last or is it transient? maybe you play the guitar too much and your muscles ache? :)

Q. What Causes Acute Appendicitis? I've heard that appendicitis is a very common situation. What causes it to happen? Is there a way to avoid it?

A. Appendicitis is caused by an infection of the appendix, usually from bacterias that are already located in the abdomen. It is not a situation that can be avoided and can occur in a high prevalence in the population.

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